Dra. Bernardita Troncoso1, Dr. Pedro-José López1-2
Paediatric Urology Department
Hospital Exequiel Gonzalez Cortes1 & Clínica Alemana 2
Santiago- Chile

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  1. Anterior urethral valves, diverticula and megalourethra

These anomalies, which are confined to males, are eight times less prevalent than posterior urethral valves. In many aspects they constitute a continuum of urethral pathology while also being distinct entities in their own right. It is difficult to define the point at which the urethral dilatation proximal to anterior urethral valves constitutes a diverticulum, and similarly the point at which an extensive diverticulum becomes a megalourethra.

- Anterior urethral valves (AUV) are a much less common cause of infravesical obstruction, with as much potential morbidity as posterior urethral valves. As classically described, these take the form of either a fenestrated diaphragmatic membrane or a mucosal cusp arising from the ventral wall of the urethra. Because anterior urethral valves are occasionally found at the distal end of a diverticulum, it is unknown whether the anomaly developed primarily as a diverticulum with undermining of the distal urethra and secondary development of valvular obstruction or early valvular obstruction that resulted in proximal maldevelopment of the urethra and spongiosum.

Endoscopic treatment does leave the patient with a urethral diverticulum in most cases. An occasional patient with a huge diverticulum and a defect in the spongiosum may benefit from open repair, which allows reconstruction of the valve, diverticulum, and investing tissues. In a rare patient with severe renal disease associated with obstruction, a temporary cutaneous vesicostomy may be used to allow drainage and improvement in renal function.